PROGRESS OF MEDICINE
ST. BARTHOLOMEW'S HOSPITAL.
THE PROGRESS OF MEDICINE
ST. BARTHOLOMEW'S HOSPITAL.
DELIVERED AT THE
OPENING OF THE SESSION
THE ABERNETHIAN SOCIETY,
OCTOBER 16th, 1888.
NORMAN MOORE, M.D., F.R.C.P.,
ASSISTANT PHYSICIAN TO ST. BARTHOLOMEW'S HOSPITAL; WARDEN OP THE
COLLEGE AND LECTURER ON PATHOLOGICAL ANATOMY TO THE HOSPITAL ;
ASSESSOR TO THE REGIUS PROFESSOR OF PHYSIC IN THE
UNIVERSITY OF CAMBRIDGE.
ADLARD AND SON, BARTHOLOMEW CLOSE.
THE PROGRESS OE MEDICINE
ST. BARTHOLOMEW'S HOSPITAL.
When I was asked to give the opening address to the
Abernethian Society this year I felt great difficulty in the
choice of a subject. The range of medicine is wide,
and of course it would have been easy to choose one of
the many divisions of the science in the study of which
all of us are spending our lives, but a subject of that
kind, dealing with the advanced part of medical studies,
is not perfectly suited to a meeting in which some of the
audience have only just begun to study medicine, while
others are so far advanced in it that they have already
made additions to medical knowledge.
Since one of the objects of the Abernethian Society is
to further the advance of medicine, I have decided to
endeavour to set forth the gradual progress of medicine
at St. Bartholomew's, from the earliest times to the present
day, as a subject likely to interest both those senior mem-
bers of the Society who have ah'eady attained distinction
in medical knowledge, and those junior members who are
beginning their studies and ought to be encouraged to work
for the day when their names may become illustrious in
the history of St. Bartholomew's.
I know no profession in which men are less likely to
believe a thing because it has been stated for a very long
time, than in that of medicine. This turn of mind, which
is observable in students as well as in doctors, was almost
the first thing that struck me when I came here from the
University. I can never remember, when I was at Cam-
bridge, feeling the slightest hesitation or doubt about
accepting as incontrovertible truth the statements of the
distinguished persons who lectured to me on the De Falsa
Legatione of Demosthenes, and the Epistle to the Colos-
sians, and I was at first astonished and afterwards pleased
to notice another disposition at St. Bartholomew's. A few
days after coming here, I heard Sir James Paget make
some remarks about a case as he went round a ward,
when a student who was present differed from him on
some point, and that distinguished surgeon, instead of being
horror-struck at the student's presumption, took pains to
prove that his own opinion was right, and on what grounds
it was based. This peculiarity, I hope, will always continue
to characterise students of medicine — this resolution not
to accept anything which is not quite clearly put before
them. This wholesome frame of mind, however, sometimes
leads us to be too careless of what was done in former times.
We are generally a little inclined to go too far on the side of
believing in ourselves and our contemporaries, and there-
fore I believe it to be of practical use for us now and then
to consider how our present knowledge was acquired, as
well as what it actually is, and to learn how men have
reached the advanced stage in which we sometimes believe
ourselves to be. The motive which has induced me to
look into what has occurred in past times is that I hope
from the past to learn something of actual use to us in the
pi-esent. That is the reason I am anxious to lay before
you to-night what is of course only a small fragment of
the history of the progress of medicine in this Hospital.
There is no place in England where that study may be
more appropriately begun and followed up than in St.
Bartholomew's Hospital. We are in the very middle of
the sacred land of Medicine, and many of the great events
in the history of Medicine in England are connected with
the particular region in which our Hospital is, or have
occurred in our Hospital itself. It has flourished as a
Hospital on its present site for more than seven hundred
and fifty years, and its Smithfield gateway, through
which passed men of the generation whose fathers saw
William the Conqueror enter London, has ever since been
open to the sick poor. The College of Physicians, the
first academical foundation of Medicine in England, was
long situated within a few hundred yards of our gates.
The founder of that illustrious College and most of its
fellows for two centuries lived within a short distance
of this Hospital. The place is surely appropriate to an
examination of the prdgress of Medicine.
How ought the inquiry to begin ? Clearly the basis of
all medicine is the patient. A patient must be the very
beginning, and is also the end of our study, so that I may
rightly begin by endeavouring to discover who was the
first patient and what was the nature of his disease who
was admitted into this Hospital, and it is interesting to
know that it is possible to discover the admission of a
patient at a very early date. The earliest patient whose
admission is recorded and whose symptoms are related is
described in the life of our founder Rahere. I should
recommend anyone who cares for the history of St. Bartho-
lomew's to look at the manuscript when he goes to the
British Museum. Anyone may get it out and examine it
to his heart's content. It belonged to Sir Robert Cotton,
who had in his library the busts of the Roman Emperors
at the head of each of the book-cases, and the books were
marked after the bust under which they happened to be
placed, so this manuscript is known in the British Museum
as Vespasian B.IX. This manuscript was actually written,
as by comparing it with other manuscripts you may easily
make sure, in the reign of Richard II. That is the
period of its writing, but when you read it you will find
that it is itself a copy of a manuscript of a much earlier
date, composed in the reign of Henry II, within fifty
years of 1123, the date of the foundation of this Hospital.
It gives an account of the life of our founder, written by
a man who had known those who knew Rahere, though
he himself had not actually seen him. It is full of
interesting particulars of the commencement of this place.
In this manuscript is the account of the admission of the
first patient of which we have any record. So you see
there is clear and distinct documentary evidence of a
patient admitted here in the reign of King Henry II.
" An nothir man Adwyne by name in the towne of
Dunwych 1 that dwellid on the see syde, so was contracte
that he myghte nat use the free office, nethir of hande,
ne of fote, his legges were clevynge to the hynder parte
of his thyes, that he myghte nat goo, and his handis
turnyd bakewarde, no thynge with them myght be do, ne
worke : the extremyteis of his fyngers were so rigorisly
contracte in the synowys, that he myght unneith put mete
to his moweth. 3 In this grevous sykenes he passid his
yonge age. And whan he attayned to mannys age and
not yette hadde he power of his lymmys, yette sith the
fame of tokenys and myracles of the blessid apostle come
to hym by relacion of othir men, he began to leyfte up his
sorowfull soule in to abetter hope. And thow helth
were yn that tyine dilaid, it was promysed to come.
The rf ore, for that he was ferre from that chirche, he
yave shipmen for hyr hyyr and by shippe he was browght
to the chirche, and put yn the hospitall of pore men.
And ther a while of the almes of the same chirche y
sustenyd. And he began yn the meyn while, by the
vertu of the apostle to take breith unto hym, and he
desirid helth,' by certeyn incrementys began to come
ageyn ; ffirst with handys thow they were crokyd, he dyd
make sniale workys as disstafes, and antell, 4 and othir
wommenys instrumentys, and forthermore by succession,
whan othir membrys usyd their naturall myghte he fol-
lowid yn greter workys, hewerrys of wode with axe, 5 and
squarerys of tymbyr with chippynge axe, 6 and nat longe
1 Iu Suffolk.
' vix ori escas porrigebat.
3 ea optata sanitas.
4 antell, percsa, weights.
5 hewerrys of wode with axe, cesores lignoruui securi.
6 et dolabra niagnis operilus imitabatur.
aftir, the crafte of carpentrye, yn the same chirche, and
yn the cite of London he exercisid, as it hadde be taught
hym from his childehode, blessynge God, whoes yen, be
oon them, that dredith hym, and uppon them that hope on
By ship he was brought to the Church, that, of course, is
the Church of St. Bartholomew the Great, still standing
in Smithfield, in connection with which at that time
there was a Priory of Augustinian Canons. In this life
there are many accounts of people who came to Rahere's
tomb in the Church and believed themselves to be cured,
and there is no reason to doubt that they did recover from
the conditions in which they are described to have been.
These cannot be reckoned as cases admitted into the hos-
pital ; they were merely people who went to the church
and performed their devotions there and weut away
better than they came. But of this man, Adwyne, it is
distinctly added he was admitted into the Hospital of
poor men. By long lying in bed his muscles had become
antemic and enfeebled. They evidently encouraged him
in the Hospital to move his limbs a little, and he was able
to move them much more than he expected ; he began
to make small things, commencing with cutting and
carving, and so at last was able to work again and to
follow the craft of a carpenter.
This is the first case of which we have any record in
the Hospital, and the only admission to it mentioned in
Rahere's life ; but though the condition of the patient is
described no details of his treatment are given. He was
discharged cured ; a fortunate beginning for our statistics.
Our Founder began by building the Hospital and then
went on to construct the Priory, of which St. Bartholo-
mew's Church in Smithfield is the only remaining frag-
ment. The Hospital was from the beginning indepen-
dent, but Thomas, his successor, like Rahere himself,
passed from the headship of the Hospital to that of the
Priory, and the Canons profited by the proximity of a
place of medical study.
The manuscript I have just quoted was composed in
the reign of Henry II, but the oldest existing copy was
made in the reign of Richard II, and it is in that very
reign that the next material for the history of our medical
progress is to be found. In that reign John Mirfeld,
a Canon of the Priory, wrote a general treatise on medicine
about the year 1380. The book is called ' Breviarium
Bartholomei,' and as Mirfeld mentions cases which had
occurred in his own observation there can be no doubt that
he did not neglect the opportunities of the Hospital though
the Priory was his proper home. The ' Breviarium Bar-
tholomei ' shows what were the knowledge and practice
of medicine in St. Bartholomew's when Richard II was
king of England and William Wakeryng master of the
Hospital. Several manuscript copies exist, of which I have
examined three, but the handsomest copy of the book is
that in the library of Pembroke College, Oxford. It is
in Latin, and the date is indicated by a calendar for the
year 1387, which is prefixed to it. It was written in the
lifetime of Mirfeld, for a document of the year 1392
shows that in that year he represented the Priory in a
The Pembroke manuscript is in its original binding
and begins with an annotated calendar.
The physician of the fourteenth century " was grounded
in astronomye," and needed a calendar to calculate the
effect of the heavenly bodies upon his remedies and upon
" Wei cowde he fortunen the ascendent
Of his ymages for his pacient."
Mirfeld himself often refers to the calendar, as in his
chapter on injuries of the head : " The astronomers say
that if any one is wounded in the head when the moon
is in the constellation of the Ram his wound is seldom
or never cured, unless trifling."
The ' Breviarium Bartholomei ' itself begins with a
finely illuminated page. In the initial is a figure of St.
John the Baptist in his camel-hair garment bearing a lamb
in his hand ; at the foot are the arms of the Benedictine
Abbey of Abingdon. This Abbey had a Hospital at its
gate dedicated to St. John the Baptist, of which this
medical manuscript was no doubt once the property. It
probably came to Bradgates Hall, now Pembroke College,
soon after the dissolution of Abingdon Abbey. At the
top of the page is written in red : — Here begins the
book which is called Breviarium Bartholomei, composed
by the venerable man, John Mirfeld, resident in the
Monastery of Saint Bartholomew in London, from which
that book is named.
In the beginning, says the prefatory chapter, of this
compilation, as in all our works, let us give thanks
to God. Memory is slippery ; this makes it wise to
collect what is known of medicine into a summary. And
another reason for the book is that there are so many false
physicians about who commit frauds upon the public.
The book is spoken of as a compilation, and this is what
all the medical books of that day are. Reading was
thought more important than observation, and the main
part of all their chapters is what they had read or heard,
with only here and there scattered passages of what they
The ' Breviarium ' is divided into fifteen parts :
The first, is of fevers ; the second, of affections of the
whole body ; the third, of affections of the head, neck, and
throat ; the fourth, of the chest and its contents ; the fifth,
of the abdomen ; the sixth, of the pelvic organs ; the
seventh, of the legs ; the eighth, of boils ; the ninth, of
wounds and bruises ; the tenth, of fractures and disloca-
tions and twists of bones ; the eleventh, of dislocations of
joints ; the twelfth, of simple medicines, the list of which
is gone through in alphabetical order ; the thirteenth, of
compound medicines ; the fourteenth, of purgatives, and
the fifteenth, of the preservation and recovery of health.
The plan is that of most of the medical books of the
Middle Ages. The preface is always succeeded by an
elaborate treatise on fevers, based upon the classification
It is curious that in his section on the pestilential fever
Mirfeld does not mention the Black Death, which had raged
in England so near his time. He gives, however, a pre-
scription, which was probably that used by the brethren of
St. Bartholomew's in that dreadful epidemic, and which was
told him by brother John Helme. It was a powder made
of equal parts of aloes and eastern crocus, mixed and dis-
solved in warm wine slightly sweetened. The chapter on
pestilence ends with a prayer to be repeated in epidemics.
Cattle plague is to be warded off by a method which
may be forgiven for approaching magic, since it inculcates
charity. Its substance is; — That cattle shall not die all the
year through. On Christmas eve let three poor travellers
be entertained, and beds made up for them of hay. And
let that hay be placed daily between oxen till Twelfth day,
and by the goodness of God they will be safe for the whole
year, as is said. — Mixed up with the medicines recom-
mended for the treatment of fevers are prayers for parti-
cular occasions of the disease, and these are sometimes
associated with practices taken from the prevalent folk
lore. A little twig of hazel, a foot long, is to be broken
in the middle. The two parts are to be held a little way
apart and certain words repeated, and by virtue of the
words the twig becomes united in some place. Here it is
to be held by finger and thumb, and the rest cut away so
that there is a little cross. This the feverish man is to
hold above him, and to say some words in French, and
five pater nosters, and he will be healed, as has often been
proved, says the ' Breviarium.'
Mirfeld had certainly witnessed the long wakefulness
of typhus fever. That terrible vigil in which the patient
lies upon his back, with his eyes wide open, hour after
hour, drawing closer and closer to death. It may well
make the physician mistrust his resources. There is no
superstition in Mirfeld's prayer for this season of trial,
for the quflint legend of the Christians of Ephesus, who
outslept the age of persecution, and on waking communi-
cated the ways of the primitive Church to a later genera-
tion, was received as undoubted history in his day. Stand-
ing by such bedsides, Mirfeld said :
" Oh Lord God ! Father Omnipotent, who showedst thy
holy mercy on thy seven holy youths, Maximian, Malain,
Dionysius, Marai, John, Constantine, and Serapion in the
City of Ephesus, whom thou madest to sleep so long. So
do by thy holy love to thy servant here, that he may rest
with quiet sleep, and by sleep he may grow well, with
soundness of body and of mind, to glorify and praise thy
holy name, which is blessed, world without end. Amen."
He was not afraid to bend over the patient in close
attention to his wants, and recommends that the thickly-
furred tongue shall be wiped with a linen rag, moistened
in acid juice.
If in doubt whether the patient be still alive his prac-
tice was to put a little burnt lard to the nostrils. If alive,
he says, the patient thereupon scratches his nose.
In Part II skin diseases are described, and couplets
are often given as aids to recollect their names and
Leprosy was then common in England. The palace
which gives its diplomatic name to the court of England,
was then St. James's Hospital for Lepers, and there were
several other foundations for them in London. It is now
so rare in London that few physicians have seen more
than one or two cases. A few years ago a leper was for
a long time in St. Bartholomew's. His face was dread-
fully deformed by the thickening of the skin, and no one
could have guessed that he was only twenty-one. He had
acquired the disease in Asia Minor, where he was born,
and long suffering had soured his disposition. His only
friend was a Manx cat, which he brought in with him,
and which, on going out, he begged the sister of the ward
to treat kindly for his sake. Treatment did not at all
improve his case, and he confirmed a remark which,
Mirfeld says, Platearius, a learned doctor of Salernum,
made to a friend, " I confess that all kinds of leprosy are
Mirfeld himself treated leprosy, he tells us, with some
success with golden pills and a restricted diet. This
included bread, two parts rye and one third barley, clear,
well scented wine, game ratber than flesh of domestic
animals, and eggs. Cheese, pulse, hares, salt meat, and
putrefied food were to be avoided.
The leprosy in one of his cases was relieved for three
years, but after that appeared again. The virtues of
sulphur water as a remedy for scabies were known to him.
Ointment made from goose-fat is one of his chief
remedies for gout, and these verses show how it is to be
" Anser sumatur
Veteranus qui videatur.
Que subternus noroinatur
Trita caro tota
Catti mox pelle remota
Mel sal f uligo
Faba pondere jungitur equo
Thus cera? sagmen ovinum.
Post hoc assatum
Tunc assus non commedatur
Sagmen ut accipiatur.
Dat gutte cuique levamen.
Valet hoc super omne talentum."
The fat of the badger is also recommended, and this
remedy is still believed in in the north of Ireland, where
I once knew a farmer on Horn Head who had a quantity
of badger fat which he used to rub on painful joints.
Yew and ivy juice should be mixed in the ointment
according to Mirfeld.
Gout was, of course, common in London in Mirfeld's
time, and lie may have been consulted about a gouty nun
of his time, the records of whose case I have read at
St. Paul's. She was of the convent of St. Helen's,
Bishopsgate, and the gout prevented her from attending
services in her choir. Constancia the Prioress, and
Margareta the Sub-prioress, locked her up and put her on
low diet. She appealed to her ecclesiastical superiors,
and at last the question was decided by Pope Urban VI
in 1385. His brief finally settles the case, and orders that
poor Joan Heyron, the nun of St. Helen's, afflicted with
gout in her hands and feet, shall be released from her
vows and allowed to go out of the convent, and shall
receive a pension from it for the rest of her days.
Mirfeld treated chronic rheumatism by rubbing the
part with olive oil. This was to be prepared with
ceremony. It was to be put into a clean vessel while the
preparer made the sign of the cross and said the Lord's
Prayer and an Ave Maria, and when the vessel was put
to the fire the Psalm, "Why do the heathen rage" was
to be said as far as the verse, " Desire of Me, and I shall
give thee the heathen for thine inheritance." The Gloria,
Pater Noster and Ave Maria are to be said, and the whole
gone through seven times. " Which done let that oil be
The mixture of prayers with pharmacy seems odd to
us, but let it be remembered that Mirfeld wrote in a
religious house, that clocks were scarce, and that in that
age and place, time might not inappropriately be measured
by the minutes required for the repetition of so many
verses of Scripture or so many prayers. The time
occupied I have tried, and found to be a quarter of an
Mirfeld gives a well-sounding definition of dropsy.
" It is a failure of the digestive power in the liver causing
distension of the limbs," but neither he nor any other
medical writer had any real knowledge about the subject
till after Lower, in 1669, showed that dropsy followed the
obstruction of the veins of a limb.
One of Mirfeld's methods of treatment was a bath of
He has many remedies for jaundice, and mentions in
his account of them that he had studied at Oxford where
Master Nicholas Tyngewich narrated from his professional
chair how he had heard of an old woman who cured
jauudice. He rode forty miles to see her and gave her a
sum of money for knowledge of that cure. Here is the
" Take an apple and let it be divided into four parts.
On the first part write + In nomine patris + ihesus + and
give to the patient to eat, and if not thus cured write on
the second part + et filii + nazarenus + and in the third
part write + spiritus sancti + Amen. + rex judeorum +
crux Cristi 4- Amen + and the first part must beforehand
have been hidden where no man could find it."
It is curious to note that nearly three hundred years
later this method of cure is mentioned as being used by
quacks and popular in London.
Mirfeld often mentions English names, both of remedies
and of diseases, and speaks of variola as " smal pockes."
If the treatment of scrofula is not successful " we go
to the king, because by touch alone kings are wont to
cure that infirmity."
Mirfeld condemns inebriety on hygienic grounds, but
does not omit further reflections on the subject. "Drunken-
ness is called the mother of all vices and faults ; it is
the actual root of crimes and the origin of vices. There-
fore by every Christian it is to be sedulously avoided."
All through the book the curious mediasval readiness
to accept any explanation of a result is apparent.
The hearts of animals are not to be eaten because they
cause forgetfulness. Thus some widows of Salernum
who wept for their husbands made pasties of the hearts
of sucking-pigs, with seasoning, and after eating the
pasties forgot all about their sorrows. " Perhaps, how-
ever," adds Mirfeld, without a smile, " the hearts of
animals are not to be eaten because they are indigestible."
Part III goes on to diseases of the head and neck and
A mouse's head in a little bag hung by a string round
the neck will keep off headache.
Verses repeated in the ear are to be tried to rouse the
epileptic man as he lies on the ground. The epileptic
unconsciousness lasts, as has been shown by modern
students of the disease, a much shorter time by the watch
than it seems to a horrified onlooker, and no doubt, as
Mirfeld and other writers of his time assert, the patient
often got up after —
" Gaspar fert mirram : thus Melchior : Balthazar
Hec tria qui secum portabit nomina regum,
Solvitur a morbo Domini pietate caduco "
was repeated in his ea.r.
To a man ignorant of the fact that while the condition
which produces an epileptic fit is a temporary disturbance,
that causing an apoplectic fit is one involving actual
destruction of a part of the brain, it must have seemed
reasonable by analogy that verses should do good to an
Mirfeld recommends an empiric remedy of English
Gilbert. The following two verses are to be tied round the
arm, the Lord's Prayer being said the while. The verses
are to be written with crosses above and below each
This must be admitted to be a charm pure and simple.
Toothache was treated by putting a little brandy in
the hollow tooth.
Mirfeld nowhere tells us who taught him, but speaks
every now and then of " my master." He was once
called to a woman who had lost her speech. He rubbed
her palate with theodoricon emperisticon and with a
little diacastorium. She recovered her speech, and bore
witness to his skill.
Some of his master's cases are related at great length.
" An apothecary brought him a youth with a carbuncle on
his face. His whole neck and throat were swelled beyond
belief, and the sick man had already tokens of death ; he
had no pulse and was fainting. My master said to that
apothecary that the youth should go home for he was
about to die in a short time. The apothecary said, ( Is
there no further remedy ? ' The physician replied, ' I
believe most truly that if thou mightest give tyriacum
in a large dose there is a chance that he may live.'
Having heard this the apothecary took him home, and
was barely able to get there, and he gave to him about
two drachms of tyriacum and put him to bed. His
head and the affected part broke into profuse perspira-
tion, and after a little there was a general perspiration,
and his pulse returned. And the apothecary gave him
the dose again of his own accord, and that day he was
made whole except for a little sore place which afterwards
healed up, and my master said that he had never seen
anyone else who had recovered after being in a faint and
tremor and especially without pulse."
This account shows that Mirfeld's master was a regular
physician, and that, like Chaucer's physician,
" Ful redy hadde he hia apotecaries
To sende him dragges and his letuaries."
After observing truly enough that an injury on the
right side of the head is likely to lead to paralysis on the
left, he relates the case of one of the Canons of St. Bar-
tholomew's, who was treated by his master. The Canon
was about to get on his horse, and when the said Canon
>,ished to seat himself in the saddle that horse arose on
his two hind legs, and the Canon fell head downwards
over the crupper of the horse to earth. And fell so
heavily upon his head that straightway he lost the sensa-
tion and movement of his whole body. My master
having been called by the friends of the patient, made
them shave his head, and then rubbed in oil of roses with
a quart of warm vinegar, and sprinkled it with a powder,
and put over it a fine cloth soaked in the aforesaid oil
and vinegar, and over that fastened linen stoups and
bound with bandages his whole head, and put over all
the skin of a lamb. And every day he visited him twice,
and rubbed in ointment into his neck and as far as the
middle of his spine. On the second day the patient
opened his mouth a little. Then one of his friends
wished to try if he would eat, but the physician would
not allow it, and said, " Even if he wished to eat I would
not let him." On the third day, when a question was put
to him, he tried to answer, stammering, but he could not
form the word. On the fourth day he spoke stammeringly,
and then they handed him a thin warm drink, which he
saw and swallowed. The fifth day he took a thin tisane.
On the sixth day they gave him chicken broth. He
then began to grow stronger, little by little, and to be
able to move, but it was many days before he could
walk. When he was able to take food my master began
to prepare pills, to resolve by evacuation the residue of
the material accumulated by the fall on his head. He
recommended that he should eat the brains of birds and
fowls and kids, and thus doing he was cured. But the
poor Canon was never quite the same man again, as Mir-
feld says : " Nunquam tamen fuit ita subtilis ingenii et
bone memorie sicut prius."
His master was a bold operator. My master, he says,
thus operated in a case that came under his hands of the
daughter of a friend of his with water accumulated in the
head. This is what he did. First rubbed in sulphur
ointment twice a day, keeping a cloth of warm wool on
the head ; then he tapped the head by the cautery in
front. Water came out slowly. After a time he made a
similar hole in the back of the head and more water came
out, and in less than a year the patient was quite well.
On another occasion his master was called to a man in
prison, who in desperation stabbed himself, so that when
he swallowed, food and drink and air came out of the
wound. My master, says Mirfeld, joined the parts of the
wound decently, and covered the place with powders and
bandages, so that the man was cured within a month and
Now and then a remedy, still considered efficacious, is
mentioned, as where the ' Breviarium,' quoting Avicenna,
recommends turpentine for chronic bronchitis.
An electuary which King Carolus used to use is recom-
mended for stomach-ache, but whether this was King
Charles of Naples, who lived in 1350, or King Charles II
of Sicily, who died in 1300, or King Charles of Navarre,
or the great Karl himself, we are not told.
Several remedies rest upon the dicta of visions. A
holy man in a dream told a woman of Sicily that plantago
was good for enlarged lymphatic glands, and Galen him-
self appeared to a certain monk and recommended colo-
cynth for gout, with an external application of bdellium,
cabbages, and marjoram, and assured the monk that the
cure would be complete in three days. A remedy for oxen
was mentioned, and further on are medicines for horses.
When he gets to injuries, Mirfeld regrets that medi-
cine and surgery have become separate lines of practice.
Long ago, unless I mistake, he says, physicians used to
practise surgery, but now-a-days there is a great difference
and distinction between surgery and medicine ; and this I
fear arises from pride, because physicians disdain to work
with their hands, though, indeed, I myself have a suspicion
that it is because they do not know how to perform par-
ticular operations, and this unfortunate usage has led the
public at large to believe that one man cannot know both
subjects ; but the well-infoimed are aware that he cannot
be a good physician who neglects every part of surgery,
and on the other hand a surgeon is good for nothing who
is without knowledge of medicine.
In the part on fractures Mirfeld is not afraid to time
with precision the recovery of each broken bone. A rib
will take twenty days. A humerus or a thigh bone forty
days. He had noticed that union is more difficult in the
aged. Dislocations were reduced with an instrument,
" quod vocatur tornellus anglice wyndas."
The book on simple medicines recommends the diamond,
a stone born in India, for keeping off evil visions, for the
diamond is hostile to the devil.
Mirfeld had not tried all the experiments in chemistry
which he describes. A diamond, he says, sprinkled with
goat's blood can be cut with a leaden saw into as many
parts as you please.
The ' Breviarium ' recommends nuts as a remedy against
poison, among others those in English called " Wallheno-
Opium, he says, is of two kinds, but the second proves
to be really asafcetida. He tells a story of a trick upon
travellers played with opium. A bad host used to give
opium to travellers' horses. When a horse fell down as if
dead he used to offer money for the skin, and when the
travellers were on their way he would take vinegar, open
the horse's mouth, and pour it in, and the horse would
soon get up. Thus are travellers deceived.
The frauds of apothecaries are mentioned ; they used to
substitute the cartilage of a goat's heart for the bone
found in a stag's heart.
A little blessed water out of a font will stop frogs
croaking in the moat.
Many fully made-up prescriptions are given. How to
make gruel and how to make gingerbread are told.
G-ruellus anglicorum is made of coarse oatmeal with
the husk off, and gingerbread, which is really toffee, of
honey and ginger baked together. The receipt is :
Take a quart and a half of refined honey and half an
ounce of Cyprus ginger, and mix them and heat gently.
If the mixture is enough cooked it will grow black. If
not enough you can tell by putting a knife in it and
cooling it in the air. If then the bit cooled on the knife
is brittle in the mouth, it is done enough. Then take it
off the fire and add powder of ginger.
He glories in pills with great names : The pills of the
King of Sicily, the Parisian pills, the pills of the glorious
King Richard, the pills of the King of England.
His powders are equally grand ; the powder of Al-
mansor, the powder of Patrick of Ireland, the powder of
John Gaddesden, the dormitorium of Mr. John Wyke.
One preparation which he mentions may justly be re-
garded as the earliest preparation of our Hospital Pharma-
copoeia — it must be looked upon as the ancestor of the
plaster seen in the Surgery every day with " St. B. H."
stamped upon it, for Mirfeld calls it " Emplastrum Bar-
tholomew" This plaster is good for all wounds, whether
of the head or body, also for cancers and fistulas :
The receipt is : Take juice of the parsley and of the
plantain and boil them, and when the liquid begins to boil
add some fine wheat flour, and boil over a slow fire till
thick. Add an equal quantity of honey and thicken
If you carry a stick of agnus castus on your travels,
says Mirfeld, your feet will not get sore. Perhaps this
belief is a reason why the ladies in the Flower and the
Leaf are described as adorned with it,
M And wreaths of agnus castas others bore."
for these ladies of the leaf do not suffer fatigue and relieve
the damsels of the flower who do.
Another preventive of fatigue proposed in the ' Brevi-
arium ' is to carry a badger's foot with you.
The chapter on keeping health, which ends the book, is
based upon the most famous medical book of Salernum
the ' Regimen Sanitatis Salerni.' It is followed by an
elaborate table of contents, with the help of which it is
easy to find anything in the MS.
The picture is complete of the medical and surgical
practice in St. Bartholomew's Hospital in the reign of
Such was fourteenth century practice ; what were the
authors consulted in that age ? They are described in
some lines of Chaucer's ' Prologue :'
" Wei knew lie the olde Esculapius,
And Deiscorides and eek Enfus,
Old Ypocras Haly and Galien,
Serapyon, Razis, and Av\cen,
Averrois, Damascien, and Cuiistantyn,
Bernard and Gatesden and Gilbertin."
With the exception of ^Esculapius, for whose works
Chaucer drew on his imagination, these are all physicians
whose books are to be found in the library of the College
of Physicians. They were constantly quoted in every
medical treatise of the Middle Ages. It is quite safe to
say that you would not be able to open any work of the
Middle Ages without finding six of these authors at least
on the page. Such was the state of medicine five hundred
years ago, in the reign of Richard II. The physicians of
that time read these books, and believed everything they
contained, and when they wrote a fresh book they put
down again what they had read. They were perfectly
ready, without the slightest idea that they were not
telling the exact truth, to state such facts as that you
could saw a diamond under certain circumstances with a
leaden saw. Such were the ways of thought of the physi-
cians of those centuries — and no one seems to have risen
above them. The revival of learning at last came, and an
event took place in the neighbourhood of this Hospital,
which was to completely alter the state of medicine in
England. This was the foundation of the College of
Physicians. Its first residence was in Knight Rider Street,
in the neighbourhood of St. Paul's Cathedral. Soon after
it moved to Anien Corner, and in 1669 to Warwick Lane,
and there remained until, in the reign of George IV, it
moved to its present site in Pall Mall East. It was founded
by Thomas Linacre, and he, with five others, formed the
original College. They differed in their idea of medicine
from Mirfeld. Mirfeld saw clearly that you were to do
what you could for your patient, and that was Linacre's
aim too, but they proposed to get at it in totally different
ways. Mirfeld believed in the ancients as far as he
knew them. Linacre and his College got beyond this ;
they believed they could add much to the knowledge of
the ancients, and though they believed what Hippocrates
and Galen said was true, they did not hold it to be the
whole truth, they believed that a great deal remained to
be found out. That idea had not occurred to Mirfeld ;
he thought the whole system of medicine was already
known. The College of Physicians was founded in 1518
by Linacre, who lived in our immediate neighbourhood,
and was buried in St. Paul's, and nearly every physician
to St. Bartholomew's since 1518 has been a Fellow of that
The first regular physician here was Dr. Roderigo Lopus.
I might proceed to tell you something about all the physi-
cians who have succeeded him, of whom I have before me a
list. It would be a most interesting way of spending the
evening to mention something about each of them, but I
do not propose to follow it, for I wish to put before you
not our whole history, but only the chief steps of our
I may, however, mention a few of the physicians : — Dr.
Bright (not the person after whom the disease of the kidneys
is called, for that great discoverer was a physician at Guy's
Hospital) wrote rather an amusing treatise on melancholy,
and was the inventor of shorthand, the first man to whom
the idea occurred of taking down what was said by a series
of signs. He was followed by Dr. Doyley, still remembered
as a Spanish scholar, and he by Dr. Wilkinson, of Trinity
College, Cambridge. Then next to him came Dr. William
Harvey. Then another one, a little way on, is Dr. Francis
Bernard, whom, I think, we ought always to remember,
for when apothecary to this Hospital he stayed in London,
in this Hospital, throughout the plague. He afterwards
became a physician, and I have no doubt, because of his
devotion, was elected, on a vacancy, physician to the Hos-
pital. And so I might go on. I think you may be a little
surprised to learn how few physicians there have been on
the staff of this Hospital — including the present ones,
there have only been forty-nine.
Here are their names and dates of appointment. All
but four (Torner, Bright, Pate, Biddulph) were Fellows of
the College of Physiciaus.
Dr. Timothy Bright
Dr. Thomas Dm ley .
Dr. Ralph Wilkinson
Dr. William Harvey
Sir John Mieklethwaite
Dr. Christopher Teartie
Dr. Arthur Dacres .
Dr. Francis Bernard
Dr. Edward Browne .
Dr. Robert Pitt
Dr. Henry Levett .
Dr. Salisbury Cade .
Dr. William Wagstaffe
Dr. Richard Tyson .
Dr. Pierce Dod
Dr. Win, Pitcairn
Dr. Win. Barrowby (3rd) . 1750
Dr. Robert Pate
Dr. Anthony Askew .
Dr. Richard Tyson .
Dr. John Lewis Petit
Dr. David Pitcairn . . 1780
The next physician I shall mention was a resident in
our Hospital but not a member of its staff. This is Dr.
John Caius, a name illustrious in the University of Cam-
Richard Budd .
John Gideon Caulet .
William Austin .
Richard Powell .
James Haworth .
Peter Mere Latham .
George Leith Roupell.
George Burrows, Bart.
Fred. John Farre(4th)
Patrick Black .
Wm. Senhouse Kirkes
George Nelson Edwards 1867
Francis Harris .
bridge, and not less illustrious in the College of Physi-
cians. He occupied a house within the Hospital at the
annual rent of £4 a year. During Dr. John Caius'
lifetime occurred one of the epidemics of what was called
the sweating sickness, a curious febrile disorder first
noticed in the reign of Edward IV, and frequently after-
wards. Dr. Caius wrote a treatise on it, which may be
called the first original treatise on medicine published
in England, by which I mean the first treatise in which
the modern idea of observing the disease and writing a
complete account of what was actually seen was carried
out. He was thoroughly versed in the expressions of
Galen and Hippocrates, and of course to us many of his
hypotheses seem extremely improbable, but his observa-
tions are also deserving of respect.
" This disease is not a Sweat onely, (as it is thought &
called) but a feuer, as I saied, in the spirites by putrefac-
tion venomous, with a fight, trauaile, and laboure of
nature againste the infection receyued in the spirites,
whervpon by chaunce foloweth a Sweate, or issueth an
humour compelled by nature, as also chanceth in other
sicknesses whiche consiste in humours, when they be in
their state, and at the worste in certein dayes iudicial,
aswel by vomites, bledinges, & fluxes, as by sweates.
That this is true, the self sweates do shewe. For as in
vtter busineses, bodies y' sore do labour, by trauail of
the same are forced to sweat, so in inner diseases, the
bodies traueiled & labored by the, are moued to the like.
In which labors, if nature be strog & able to thrust out
the poiso by sweat (not otherwise letted) y c perso
escapeth : if not, it dieth. That it is a feuer, thus I
haue partly declared, and more wil streight by the notes
of the disease, vnder one shewing also by the same notes,
signes, and short tariance of the same, that it consisteth
in the spirites. First by the peine in the backe, or
shoulder, peine in the extreme partes, as arme or legge,
with a flusshing, or wind, as it semeth to certeine of the
pacients, flieng in the same. Secondly by the grief
in the liuer and the nigh stomacke. Thirdely, by the
peine in the head, and madnes of the same. Fourthly by
the passion of the hart. For the flusshing or wynde
commiug in the vtter and extreame partes, is nothing els
but the spirites of those same gathered together, at the
first entring of the euell aire, agaynste the infection
therof, & flyeing thesame from place to place, for their
owne sauegarde. But at the last infected, they make a
grief where thei be forced, whiche comonly is in tharme
or legge (the fartheste partes of theire refuge) the backe
or shulder : trieng ther first a brut as good souldiers,
before they wil let their enemye come further into theire
dominion. The other grefes be therefore in thother partes
aforsaid & sorer, because the spirites be there most
pletuous as in their founteines, whether alwaies thinfection
desireth to go. For fro the liuer, the nigh stomack,
braine, and harte, come all the iij. sortes, and kyndes of
spirites, the gouernoures of oure bodies, as firste spronge
there. But from the heart, the liuish spirites. In
putrifieng wherof by the euel aier in bodies fit for it, the
harte is oppressed. Wherupon also foloweth a marueilous
heauinesse, (the fifthe token of this disease,) and a desire
to sleape, neuer contented, the senses in al partes beynge
as they were bounde or closed vp, the partes therfore left
heuy, vnliuishe, and dulle. Laste foloweth the shorte
abidinge, a certeine Token of the disease to be in the
spirites, as wel may be proued by the Ephemera that
Galen writethe of, whiche because it consistethe in the
Spirites, lasteth but one natural day. For as fire in
hardes or straw, is sone in flambe & soue oute, euen so
heate in the spirites, either by simple distemperature, or
by infection and putrefaction therein conceyued, is sone
in flambe and sone out, and soner for the vehemencye or
greatnes of the same, whiche without lingering, consumeth
sone the light matter, contrary to al other diseases
restyng in humoures, wherin a fire ones kindeled, is not
so sone put out, no more then is the same in moiste
woode, or fat Sea coles, as well by the particular Example
of the pestilence, (of al others most lyke vuto this) may
be declared, whyche by that it stadeth in euel humors,
tarieth as I said, sometyme, from iiij. vii. ix. & xj. vntill
xiiij. dayes, differentlie from this, by reason therof, albeit
by infection most lyke to this same. This vnder one
laboure sbortelie I haue declared — both what this disease
is, wherein it consisteth, howe and with what accidentes
it grieueth and is differente from the Pestilence, and the
propre signes, and tokens of the same, without the whiche,
if any do sweate, I take theym not to Sweate by this
Sickenesse, but rather by feare, heate of the yeare, many
clothes, greate exercise, affection, excesse in diete, or at
the worst, by a smal cause of infection, and lesse disposi-
tion of the bodi to this sicknes. So that, insomoche as
the body was nat al voide of matter, sweate it did when
infection came : but in that the mattere was not greate,
the same coulde neyther be perilous nor paineful as in
others, in whom was greater cause."
You see he has tried to describe what he observed, and
if you separate it from the phraseology of his time — which
did not in any way spoil his observation — he has clearly
told from personal observation the onset and progress of
the disease. He says it is true it is rather like the
syrocbus of Galen, but all the same gives a clear descrip-
tion from what he had himself seen. It was in all pro-
bability a violent kind of influenza. Now, Dr. Caius
was a most learned man, and he believed that in Galen
much truth was to be found. He believed that what the
ancients said was true and of authority, but he also
believed that there was a great mass of medicine to be
found out by observing patients and by describing their
symptoms, and by examining their bodies after death,
and he entirely rejected all the compiling authors of the
middle ages. He and the physicians of the College
thought that Hippocrates and Galen were always right,
but that much was to be learned from our own individual
observation, and they approached the belief that more was
to be learned at the bedside than in the library. This was
a great advance. Dr. Caius continued to live in St.
Bartholomew's Hospital for many years. The first dinner
— the first banquet of the College of Physicians — was held
at this Hospital in Dr. Caius' house in 1554. At the
present day, when the President of the College of Physi-
cians takes the chair at the comitia majora of the College,
a meeting which consists of the President and all the
Fellows, he bears in his hands, as a sign that the meeting
has begun, a silver sceptre, on the top of which are
four little serpents. This sceptre was made at the
expense of Dr. Caius, and after it was made the College
had this dinner at Dr. Caius' house in this Hospital.
Dr. Caius died in 1573. Shortly before the year 1609
Dr. William Harvey came to this Hospital from Cambridge.
Harvey was a physician of the same kind as Caius, and I
think we ought to remember low very much Caius did
towards encouraging the study which led to the great
discovery of the circulation of the blood by Harvey.
Caius left money so that there should always be dissec-
tion of the human body, the actual study of anatomy
going on at the College of Physicians and at Cambridge,
and it was that opportunity of knowledge while at the
University that made Harvey such a proficient in anatomy
as he actually was. So it was Dr. Caius who was the
means of leading Harvey to his discovery.
Harvey gave in 1616 the lectures at the College of Phy-
sicians in which the circulation of the blood was first
announced. It is worth considering well what kind of a
physician Harvey was, for he is certainly by far the most
illustrious person who has been on the staff of this Hos-
pital, and the one who has done most to further the
progress of medicine.
What stage had he reached in the course of medical
progress ? If you look at the biographies of Harvey — many
of them are careless — you see it stated that it is doubtful
whether he was a great physician in his own time. There
is no ground for this assertion : he certainly was a great
physician — his object in life was the treatment of patients ;
literature as well as science interested him ; but his whole
wish and desire was to learn to cure disease, and the
statement that Harvey was not thought distinguished in
his profession in his own time can be traced to a remark
of a non-medical writer of the period, Mr. Aubrey, who
wrote a gossiping volume of personal recollections.
If you look into Harvey's works, his lectures on
anatomy and his book on the circulation of the blood,
you will find that he was first of all, and all through his
life, a physician anxious to cure patients. Like Linacre
and Caius he had great respect for the ancients. He
thought Galen worth careful study. A few weeks ago I
had to go to the British Museum for something else, and
happening to take out a copy of Galen noticed that it had
upon it notes by Harvey, undoubtedly in Harvey's hand-
writing. Now, Harvey had a habit, when he wrote down
what he thought original, of putting his own initials,
" W. H.," against it. In this Galen, Harvey has thus
placed his initials after several manuscript notes. He
had studied Galen carefully, and all these treatises are
carefully annotated throughout in his handwriting. It
would not have needed this, however, to assure us he was
deeply versed in ancient medicine, for in his lectures he
often refers to all the old authors. He had thought
deeply over Aristotle ; and in one lecture he says that it
was a passage of Aristotle which first suggested to him
the idea of the circulation of the blood.
The medical authors so often quoted by Mirfeld are
never mentioned by Harvey. Taking Harvey's lectures
on anatomy — of which the manuscript was published in
1886 — much may be learnt of his medical attainments.
They do not read continuously, they are the actual notes
of his lectures, written largely in Latin, and partly in
English. He was lecturing on anatomy, so he only used
medicine as an illustration ; and no doubt what he ac-
tually said was much more full than what is left in
writing. To take his account of the liver as an example ;
he describes ten conditions which are all now well known
to us. He does not explain their pathology, but by de-
scribing them he made the first step in the direction of
explanation, and his remarks on the liver are a fair example
of how rich in observation his notes are. It is worth
while to interpret his quaint expressions.
(1) " Item russetish Ingentem et durum plane scirrus
tumor absque pene sanguine aspera superficie."
This russet-coloured, large, hard, scirrhus-like, bloodless
liver with a rough surface, we should call a case of cir-
(2) " Between russet and purple as big as an ox liver
Jhon Bracey extentum," was probably an amyloid liver.
(3) " Begining to be discolored Joan Johnson mortua
ex febre maligna," was the swollen liver of raised tem-
(4) " Palish dirty color cum mucca on ye coat.
Hydrope resudante materia little blathers or tanquam
blisters," is the liver of general peritonitis.
(5) " Like a heap of pus colore subfavescum noe shape
nor particle remayninge Jecoris," was probably a large
abscess of the liver.
(6) " Ut plurimum ubi in Hydrope vel alias ubi Jecur
russetish splen watchet greenish or lead color si morbo
ex cachexia," describes the thickening of the capsule
often found after death with chronic peritonitis.
(7) "Apostema ingens per multos menses ex pure
fcetidissimo 2 or 3 gallons et aqua cum viscosit panni-
culis convolutis as glew stepened in water or Isonglass :
The little sticky rags like glue or isinglass and the
large quantity of fluid show clearly that he is describing
a great hydatid cyst filled with fluid and daughter cysts.
(8) " Mortua Inflammatio Jecoris of a botch in tunica
This botch was a mass of new growth.
(9) " Absessulaa ut cuniculis."
This was probably a liver of pyaemia with many small
(10) " Extenuato cum felle magis disfcentum ut urina
et calculis referto ab ictero."
This liver distended with thin watery bile and with
gall-stones was of the form of cirrhosis due to long-
continued obstruction of the common duct.
These are ten distinct and most important observations
on the condition of the liver. If you compare these
observations of his with any earlier works you will see
that Harvey really belonged to our time, and that in
his opinion you are to learn how diseases are produced
not only by poring over books but by examining the
body after death, and comparing the anatomical appear-
ances with the symptoms observed during life.
The physician to St. Bartholomew's in Harvey's time,
learned and valuable as he was, did not do all the work of
the Hospital ; on the contrary, a great part of the laborious
work of the Hospital was done by a man who was not
thought distinguished enough to come as a guest to the
dinner at Dr. Caius' house, though they had him in after
dinner to warn him what he must not do, and that man was
the surgeon. He was a member of a company in the City of
London which for a long time had a hard struggle to live
among the companies, and he practised an honest occupa-
tion and hoped always " to hold himself as a good artist."
But he was in a very subordinate position in the Hospital,
and had very few opportunities of improving himself with
the learned persons of his time ; and the next step I wish
to point out to you is how the surgeon came to improve
himself. He was not even allowed to see the prescrip-
tions, for they were carefully locked up. He nevertheless
took to observing — observation of patients had been set
before mankind as the way to find out about disease.
The surgeons took earnestly to observing. The physicians
for several centuries had been reading, and then came to
observing at St. Bartholomew's, but you will notice that
the surgeons had read very little, and began to observe
before they had read much. Of course, they knew how
to read, but were not learned book men. At last the
time came when there appeared a really learned surgeon,
a surgeon who had not only observed but read. That
surgeon was Charles Bernard, who worked here from
1686 to 1710. He was surgeon to Queen Anne, and
had one of the finest libraries of his time. The College
of Physicians possess some of his books, and in one of
the books now in the library there is written his name,
Caroli Bernard : Chir : Lond : in his own handwriting.
He was not only well read but was one of the best
observers of his profession. I believe it is to him we
owe first the observation that new growths are likely to
recur, and this ought to be remembered in connection
with his name. He was a person of extraordinary learning
and pleasant conversation, and Swift mentions his death
with regret. He was the scientific ancestor of the learned
surgeons who since his time have continued to flourish
here — Pott, Abernethy, Lawrence, with those no less dis-
tinguished ones who flourish at the present day, and
whose names are so well known to you.
From Bernard's time there ceased to be any great
difference in culture and distinction between the members
of the Staff, and in that very period, in the time of
Charles Bernard, an observation was made here by a
frequenter of the Hospital, a person buried in St.
Andrew's, Holborn, of whom we have all heard, though
when I tried to learn exactly who he was from several
anatomists, I could not learn from them his Christian
name, when he lived, or anything about him. This
person was Douglas, after whom the fold of Douglas
is called. Douglas was a physician in London, and he
constantly attended this Hospital, and went round the
wards. In ] 716 he describes very clearly in a paper
in the ' Philosophical Transactions,' the general appear-
ances of amyloid disease of the spleen, but not, of course,
the appearance produced by adding iodine, in a case of
marasmus with strumous enlargement of the lymphatics.
This was not a very thorough discovery ; but another
thing he made out is very much more remarkable. He
says that while he was going round the Hospital of St.
Bartholomew he saw a young man suffering from palpita-
tion, and that as his heart beat he could hear a distinct
sound with the beating of his heart. The man died and
Douglas describes how at the post-mortem he saw the
heart was enormously enlarged, and the aortic valves
were contracted and hard so as to allow the blood to
flow back into the ventricle. He had thus discovered
the murmur caused by aortic disease a hundred years
before the stethoscope came to make such observation
easy. This, then, was a great step in medicine actually
made in the wards of this Hospital. Another step made
a little later in the century ought always to be remembered
here, although it may seem slight now-a-days, and that is
Dr. David Pitcairn's discovery that inflammation of the
valves of the heart is common in rheumatic fever.
I have tried to give you some information of what the
progress of medicine has been in St. Bartholomew's, — of
a few of its important steps. I have shown you what were
the medical ideas when the Hospital began : you know
yourselves what our present state of knowledge is. I have,
of course, not described every improvement which has
taken place but have only pointed out some of the more
important steps which have led to our present condition.
I have described how the physician grew from a school-
man into a scientific observer, and how the surgeon ap-
peared on the scene in livery and without learning and
grew from a handicraftsman to be a man of science.
Two other actors in this history remain to be mentioned.
First of all the actual student of medicine, a person to
whom, I believe that, in our own time, the progress of
medicine is enormously due. You will remember that Dr.
Thomas Young, who was the originator of the undula-
tory theory of light, made one of his discoveries while a
student here, before he was twenty years of age, and
that he was elected a Fellow of the Royal Society while
a student here. Another student — a member of this
Society — discovered trichina spiralis in muscles. He is
now well known to all the world as Sir James Paget.
But these were great and exceptional students, and
when I spoke of the value of students to the advancement
of medicine I was thinking rather of the influence which
all students exercise on their teachers, the physician and
The students' criticism must always make observation
so much more careful, and statement so much more
measured than if they were absent, that their presence is
invaluable to the patients as well as to the physicians and
surgeons. I believe it is largely to this influence that
the great progress of medical observation in recent times
has been due. You will see in our calendar a short
preface, relating how students began here soon after 1660,
but it is incomplete and does not carry the record far
enough back. Harvey himself studied here early in the
reign of James I, and it was the custom of men who
wished to study medicine to go into the wards and pick up
a little, though not to work systematically as they do now.
There is one other class of persons who have been added
to our medical life, and who are an important addition
to our means of treating patients. These, of course, are
the nurses. When Dr. Caius lived here there was in
every ward, as at the present day, a sister, but her chief
business was to maintain order, and to see that the
patients spun the proper amount of flax, and to take care
that the yarn delivered to her bore a just proportion to
the thread that went out. From that to our present
elaborate system of nursing is a great change. The pro-
gress in this direction has been very rapid in the last
few years, and it has now reached the conclusion, which
one would have thought it would have reached before,
that careful education and training produce more useful
nurses than chance. The result is that the directions
of the physicians and surgeons are carried out in a way
which was unknown before.
I have tried to show you how the Hospital began to
treat patients. First of all we had men like Mirfeld, who
looked into old treatises and compiled new ones, rearrang-
ing old information, and never correcting it by systematic
observation ; who sometimes made a sensible remark but
never added to knowledge. Then came men like Dr.
Caius and Harvey, who believed in ancient learning, but
made original observations and looked to observation as
the means of advancing medicine, so that from their day
discoveries have continuously been made here. Thus the
patient, with whom we began as the foundation of all, has
led to the creation of the physician, of the educated
surgeon, of the careful and observing student, and of the
well-trained nurse ; and that is the history of the progress
of medicine in St. Bartholomew's Hospital. I should be
sorry if I left you with any but very kindly feeling for
the times and the men under whom seven hundred and
fifty years ago our Hospital began. Their whole object
was the relief and cure of patients. They desired to do
all in their power for the sick man. In the midst of
increased knowledge, of increased means of observation,
of deeper interest in the phenomena of disease for their
own sake, let us never forget that to do all we can for
patients is the true end of medicine.
PKINIKD BY ADLABD AND 60W, BARTHOLOIIBW CLOSE, B.C.
Sou 2. 2.
Moore, Sir N.
Progress of medicine
at St. Bart's.